[hivaids-twg] [AIDS ASIA] AIDS-related and non-AIDS-related mortality in the Asia-Pacific region

Tue Nov 3 04:22:36 GMT 2009

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From: AIDS ASIA <aids_asia at yahoogroups.com>
Date: Fri, Oct 30, 2009 at 10:13 PM
Subject: [AIDS ASIA] AIDS-related and non-AIDS-related mortality in the
Asia-Pacific region
To: AIDS_ASIA <aids_asia at yahoogroups.com>

AIDS-related and non-AIDS-related mortality in the Asia-Pacific region in
the era of combination antiretroviral treatment
Falster, Kathleen; Choi, Jun Yong; Donovan, Basil; Duncombe, Chris; Mulhall,
Brian; Sowden, David; Zhou, Jialun; Law, Matthew G;

on behalf of the Australian HIV Observational Database, the TREAT Asia HIV
Observational Database

AIDS:
13 November 2009 - Volume 23 - Issue 17 - p 2323-2336
doi: 10.1097/QAD.0b013e328331910c
Epidemiology and Social

Abstract

Objective: Although studies have shown reductions in mortality from AIDS
after the introduction of combination antiretroviral treatment (cART),
little is known about cause-specific mortality in low-income settings in the
cART era. We explored predictors of AIDS and non-AIDS mortality and compared
cause-specific mortality across high-income and low-income settings in the
Asia-Pacific region.

Methods: We followed patients in the Asia Pacific HIV Observational Database
from the date they started cART (or cohort enrolment if cART initiation was
identified retrospectively), until the date of death or last follow-up
visit. Competing risks methods were used to estimate the cumulative
incidence, and to investigate predictors, of AIDS and non-AIDS mortality.

Results: Of 4252 patients, 215 died; 89 from AIDS, 97 from non-AIDS causes
and 29 from unknown causes. Age more than 50 years [hazard ratio 4.29; 95%
confidence interval (CI) 2.10-8.79] and CD4 cell counts less than or equal
to 100 cells/μl (hazard ratio 8.59; 95% CI 5.66-13.03) were associated with
an increased risk of non-AIDS mortality.

Risk factors for AIDS mortality included CD4 cell counts less than or equal
to 100 cells/μl (hazard ratio 34.97; 95% CI 18.01-67.90) and HIV RNA 10 001
or more (hazard ratio 4.21; 95% CI 2.07-8.55).

There was some indication of a lower risk of non-AIDS mortality in Asian
high-income, and possibly low-income, countries compared to Australia .

Conclusion: Immune deficiency is associated with an increased risk of AIDS
and non-AIDS mortality. Older age predicts non-AIDS mortality in the cART
era.

Less conclusive was the association between country-income level and
cause-specific mortality because of the relatively high proportion of
unknown causes of death in low-income settings.
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